APA Conference 2013: Treatment Response and Predictors of Change for Military Service Members in Intensive Treatment

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  • 1. Treatment Response and Predictors of Change for Military Service Members in Intensive Treatment Jennifer A Webb-Murphy, Ph.D. Naval Center for Combat & Operational Stress Control (NCCOSC) Bureau of Medicine and Surgery (BUMED)
  • 2. Co-authors • Susan F. Fesperman, MPH • Elizabeth A. Vishnyak, MA • Scott C. Roesch, PhD • Eileen M. Delaney, PhD • Steven K. Gerard, BA • Bonnie J. Nebeker, AA • Stephanie C. Raducha, BA • Courtney A. Dempsey, MPA • Andrea L. Repp, MA • Betsy J. Grant, MA, MFT • CAPT Scott L. Johnston, PhD, USN
  • 3. Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or United States Government. Results presented are part of the Psychological Health Pathways Research Study, which is approved by the Naval Medical Center San Diego Institutional Review Board.
  • 4. Agenda • Brief Background • Psychological Health Pathways • Treatment Response • Predictors of Change
  • 5. Mental Health Services Surge • OEF/OIF resulted in a significant increase in demand for mental health services • Military mental healthcare rapidly expanded to address demand • Resulting system is novel, broad and dynamic
  • 6. Deployment Health Emergency Room Branch Clinic Mental Health Department Unit level services Community care Residential Intensive outpatient Inpatient Outpatient Research Individual Groups Couples Family Medication Medication Medication CAM Animal Assisted Therapy Holistic Health Acupuncture Healing Touch Massage Recreational Therapy Surf Therapy Yoga Running Golfing
  • 7. Psychological Health Pathways System Solution • Clinical Pathways • Case Management • Data Management • Standardized outcome measures at baseline and 10 week intervals • Patient Summaries • Aggregate Reporting • Population Level Research
  • 8. PHP Assessment Process Clinic Patient ISR Patient 10 wks RSR TR Patient Tx Team  10 wks
  • 9. From Beta to Pilot: Paper vs. eCapture vs.
  • 10. Pilot PHP Assessments: Section A: Basic Demographics Section B: Outcome Measures – PTSD – Depression – Social, Occupational & Relational Functioning – Resilience – Sleep – TBI Screen – Anxiety – Alcohol Use – Somatic Section C: Deployment Information – Combat Exposure – Consequences of Combat
  • 11. PHP Status
  • 12. Individual Patient Summaries
  • 13. PHP Aggregate Reports
  • 14. Treatment Outcomes • Intensive outpatient treatment for substance use and PTSD – 8 week program – Variety of interventions • Residential treatment for PTSD – 10 week program – Variety of interventions
  • 15. Significant Improvements n=201 40 41 42 43 44 45 46 47 48 49 PTSD 0 5 10 15 20 Depression 10.6 10.8 11 11.2 11.4 11.6 11.8 Sleep
  • 16. Significant Improvements n=201 13.5 14 14.5 15 15.5 16 16.5 17 Functioning 40 42 44 46 48 50 52 54 Resilience
  • 17. Predictors of Change Relationship status • Never being married = larger decrease in PTSD Sx • Being married = smaller decrease in depression Living with your spouse • Smaller decrease in depression Sx • Smaller improvement in functioning Planning to leave military • Larger decrease in PTSD and depression Sx • Larger improvement in functioning • Higher increase in resilience
  • 18. Conclusions • Significant benefits of comprehensive, systematic military mental health assessment, such as PHP • Evaluate treatment progress • Identify effective programs • Successful specialized treatment • Understand population seeking care • Unique risk and protective factors • Being single and not living with spouse could result in better treatment response • Planning to leave the military doesn’t inhibit ability to obtain treatment gains